Revised Oswestry Low Back Pain Disability Questionnaire printable pdf download

REVISED OSWESTRY LOW BACK PAIN DISABILITY QUESTIONNAIRE

PLEASE READ: This questionnaire is designed to enable us to understand how much your low back pain has affected your ability

to manage your everyday activities. Please answer each section by circling the ONE CHOICE that most applies to you. We realize

that you may feel that more than one statement may relate to you, but PLEASE JUST CIRCLE THE ONE. CHOICE WHICH

MOST CLOSELY DESCRIBES YOUR PROBLEM RIGHT NOW.

SECTION 1 - Pain Intensity

SECTION 6 - Standing

A I can stand as long as I want without pain.

A The pain comes and goes and is very mild.

B I have some pain while standing, but it does not increase with time.

B The pain is mild and does not vary much.

C I cannot stand for longer than one hour without increasing pain.

C The pain comes and goes and is moderate.

D I cannot stand for longer than 1/2 hour without increasing pain.

D The pain is moderate and does not vary much.

E I cannot stand for longer than ten minute without increasing pain.

E The pain comes and goes and is severe.

F I avoid standing, because it increases the pain straight away.

F The pain is severe and does not vary much.

SECTION 2 - Personal Care

SECTION 7 - Sleeping

A I would not have to change my way of washing or dressing in

order to avoid pain.

A I get no pain in bed.

B I do not normally change my way of washing or dressing even

B I get pain in bed, but it does not prevent me from sleeping well.

though it causes some pain.

C Because of pain, my normal night's sleep is reduced by less than

C Washing and dressing increases the pain, but I manage not to

one than one quarter.

change my way of doing it.

D Because of pain, my normal night's sleep is reduced by less than

D Washing and dressing increases the pain and I find it necessary to

one-half.

change my way of doing it.

E Because of pain, my normal night's sleep is reduced by less than

E Because of the pain, I am unable to do some washing and dressing

three-quarters.

without help.

F Pain prevents me from sleeping at all.

F Because of the pain, I am unable to do any washing or dressing

without help.

SECTION 3 - Lifting

SECTION 8 - Social Life

A I can lift heavy weights without extra pain.

B I can lift heavy weights, but it causes extra pain.

A My social life is normal and gives me no pain.

C Pain prevents me from lifting heavy weights off the floor.

B My social life is normal, but increases the degree of my pain.

D Pain prevents me from lifting heavy weights off the floor, but I can

C Pain has no significant effect on my social life apart from limiting

manage if they are conveniently positioned, eg. on a table.

my more energetic interests, My e.g., dancing, etc.

E Pain prevents me from lifting heavy weights, but I can manage

D Pain has restricted my social life and I do not go out very often.

light to medium weights if they are conveniently positioned.

E Pain has restricted my social life to my home.

F I can only lift very light weights, at the most.

F I have hardly any social life because of the pain.

SECTION 4 - Walking

SECTION 9 - Traveling

A I get no pain while traveling.

A Pain does not prevent me from walking any distance.

B I get some pain while traveling, but none of my usual forms of

B Pain prevents me from walking more than one mile.

travel make it any worse.

C Pain prevents me from walking more than 1/2 mile.

C I get extra pain while traveling, but it does not compel me to seek

D Pain prevents me from walking more than 1/4 mile.

alternative forms of travel.

E I can only walk while using a cane or on crutches.

D I get extra pain while traveling which compels me to seek

F I am in bed most of the time and have to crawl to the toilet.

alternative forms of travel.

E Pain restricts all forms of travel.

F Pain prevents all forms of travel except that done lying down.

SECTION 5 - Sitting

SECTION 10 - Changing Degree of Pain

A My pain is rapidly getting better.

A I can sit in any chair as long as I like without pain.

B My pain fluctuates, but overall is definitely getting better.

B I can only sit in my favorite chair as long as I like.

C My pain seems to be getting better, but improvement is slow at

C Pain prevents me from sitting more than one hour.

present.

D Pain prevents me from sitting more than 1/2 hour.

D My pain is neither getting better nor worse.

E Pain prevents me from sitting more than ten minutes.

E My pain is gradually worsening.

F Pain prevents me from sitting at all.

F My pain is rapidly worsening.

COMMENTS:_____________________________________________________________________________

__________________________________________________________________________________________

NAME: _____________________________________ DATE: ____________ SCORE: _________________

Revised Oswestry Low Back Pain Disability Questionnaire

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